Navigating Disability and Health Data System Webinar
March 21, 2012
11:00 am ET

Transcript:
Adriane Griffen, MPH, MCHES from AUCD

Thank you for joining this webinar, Navigating the Disability and Health Data System.  My name is Adriane Griffen and I work for the Association of University Centers on Disabilities (AUCD) as Project Director for the AUCD-NCBDDD Cooperative Agreement.  I will be providing you with a few administrative items before I introduce and pass it over to our speakers for today.

Just so you know, we will be recording today’s webinar and archiving it on AUCD’s webinar library.  The text transcript of this webinar will also be made available with the recording. If you have any questions during the presentations, please submit them by typing them into the chat box feature on the webinar tool panel.  We will take a few breaks throughout the webinar to answer any questions you may have. Lastly, at the end of the presentation you will receive a link to complete a short evaluation of the webinar.  We hope that you will take a few minutes to provide us with your feedback, thoughts and reactions.

We also wanted to point you to some tools that are available to help you access and spread the word about the DHDS. Specifically, there is a button you can use available at http://www.cdc.gov/ncbddd/disabilityandhealth/tools.html to share DHDS and promote good disability and health data with your constituents and staff in a visual way using your web site, intranet, blog or other social media platforms. The web button is a more recognizable way to bookmark the DHDS location, rather than a traditional text link.  We’d also like to remind you that if you have any questions about the DHDS, you can send them to cdcinfo@cdc.gov or, call   1-800-CDC-INFO.
We are very excited to have with us today, Dr. Brian Armour and Ms. Michelle Sloan.
Dr. Armour, who has a PhD in Economics, is the lead for the Disability and Research Epidemiology team at DHDD, and has been with CDC for 8 years.  Brian has worked over 15 years in health services research and quality improvement and has oversight of Disability and Health Data System.
Ms. Sloan, who has a MA in Economics with an interest in Health Economics, has worked with CDC’s disability and health program for two years.  As a Public Health Analyst contracted by CCI and SAIC, Michelle has been leading the design and development of the Disability and Health Data System and has assisted on other disability and health research projects.
We welcome both Dr. Armour and Ms. Sloan and look forward to their remarks!
So without further ado I will pass it over to Dr. Armour for today’s interactive presentation.

Michelle Sloan, MA from CCI, SAIC:
This is the second part of a two-part series of an introduction to disability and health data systems. Last week Brian gave a great overview to the system. The first-ever state-level disability data source was provided some easily accessible standardize uses for the system and he also went through some of the benefits of the system and touched on those. We will get into a lot more detail today. This page is the Disability and Health page. A lot of you are familiar with. I want to show you how to access the system from the space-bar to you'll see here that it's a popular link. I want to show you how to get through from the left navigation over here. If we go down and click ‘data and statistics’, and then ‘disability and health data systems’, this is the landing page for the system on disability and health on CDC.gov. This page gives a lot of rich information to the system, and also a tip sheet and a fact sheet that you can download and take to some colleagues or if you just want to have reference material. 

For the webinar today, we want to give you a detailed walk-through of the system and we hope that this webinar you will leave with three major things. 1. An understanding of the data in the system, 2. knowledge on how you can find and use the data that you are interested in, and 3. an understanding of how the Disability and Health Data System can be used to generate research questions. From this page, you can get to the system by clicking on this logo or the text underneath. I will do that now. 

You will see that this is the homepage for the Disability and Health Data System. On the center of the page you'll see that we have little snippets of information for a lot of the sections: we have about accessibility, and also have some quick links to some of the key topics within the system, including, disability, mammograms, body mass index, and we will go back to the top and you'll see over here that we have a left navigation which provides links to all the sections in the system. And we will go through that and then we will really get into the data for the rest of it. As is again which of the data and we will come back to that. The ‘DHDS Methods’ provides details to the methodology of the data within the system. There are three types of data in the DHDS. Disability data and expenditure, disability and psychological distress are both taken to the risk factor surveillance system and currently we have 2004 through 2010 in the system. Disability data contained 79 indicators by health and demographics. And we have information on people with disabilities, people without disabilities, and the total, and the disparity. The disparity is the percentage point difference between disability and no disability. Psychological distress that are viable for 49 indicators for the survey year 2007, for 37 states. And there is information about that dummy page here. We also have expenditure data, which is disability associated healthcare expenditures for 2006. For more information we have written a few papers that are included in the resource section. Those will provide the details to the data on that section. 

And I will scroll back to the top of the page here. We are going to go into the help topic data. This provides a link to all of the indicator definitions in the site and we'll provide the questions that we use in order to define each of the variables. First we will click into disability status so you can see how we define disability throughout the system. You'll see here that it was designed with the Behavioral Risk Factor Surveillance System (BRFSS) two questions: 1. Are you limited in any way in any activities as a physical mental or most all problems? and 2: Do you not have any health problems that requires you to use special equipment such as a cane a wheelchair a special bed or special telephone? Respondents were defined as having a disability as they entered yes to either of both of these questions. 

Now I will go back to the previous page. I will scroll down and give you a flavor of the data that we have within the site. You can see here that we have health risks and behaviors and you can see that we really have a lot of information in the site at your disposal. Prevention and screening, and it lets you get a quick glance at those. Some general health conditions and chronic conditions. And as a reminder, and all we have 79 health demographic variables. On this page are 71 variables. These are the health topics. I’m going to scroll back up and I want to give you an idea of what this looks like. We are going to go into smoking status here because we will cover this little bit later. 

We have listed the questions that we used to define the variable and we also have the responses. For smoking status, we have respondents who reported current smoker, former smoker and never smoker. And we list the years of those are available and any related indicators and tissue want to look at some other information on the topic. We also have the paper at the bottom that we used to define this variable. When we created the data for the system, we made sure that we were defining the variables the same way that other CDC programs. We went through a paper that have been published on this topic and made sure that we know how to define the subject and the way that the CDC program would define it. I will go back to the previous page and just give you a more look at all of the data here. And we will go back up. The demographic data guide, does the same thing. We have all of the demographic indicators of your and how they were defined. Pretty straightforward but we do have the questions in here if you'd like to look in all these are available for every year, 2004 through 2010. Continuing down the page about the DHDS, this gives an overview of the system in case you want to go back to that for reference. It's basic information about what's in the system and what you can find in the system. 

And this is where we will post any updates and information about those. Accessibility provides overview and we will user centered design approach. We reached out to our partners and others for feedback into how we could develop and design the site in a way that is going to be most useful for their needs, rather than us just assuming we know best in the way this site should be set up. We reached out and try to incorporate some of the feedback that we got from our partners. We also worked really hard to try to include some components for data users who will use assistive technology so they can also have a good experience with the site. In terms of being able to see the colors in the text being large enough, and being able to access the data. And at the bottom of this page is the access key information so that you can navigate the site using a keyboard, here are the details for how you can do that. Lastly on the left tab is the help, which will open a window for all of the help resources that we have created for the site. And it's a rich amount of information you can go back to and refer to and I will go over this in detail at the end so you can see how to use this with the site in order to understand how to find some info on what you are doing. And going back to the homepage we will now get into the data. 

The Disability and Health Data System can be accessed in three ways. Through the left navigation, the browse maps and the data tables button by clicking on this image here that you seek in the maps and data tables box. Will going through the left map. And the page will load and I will show you that we have a browse data menu and you'll see the three data types and mentioned earlier. Disability data, psychological distress and expenditures. Today we will focus on disability data. And I'm going to start by clicking the plus (+) sign here. And clicking the plus-sign will open up the levels underneath and you can continue to click down and see all of the topics that we have available in the site. Which will line up with the topics you saw in the data guide that I just showed. We can click ‘Open’ and you can see how this works. Prevention and screening, cancer screenings, chronic conditions, and I will close all these backup just to keep it clean. And we will go back up into Demographics. And I will show you income levels for the one-year analysis. So this page gives you all the options that you have for viewing the indicator you have selected. Here we have the option to view it as an interactive map and standard contrast and high contrast, and interactive comparison map and interactive comparison map and I can tailor to the data you are most interested in or you can download the data set into Excel or see a pdf format. We are going to go into the standard contrast interactive map. And that's going to load on the page here in just a second. 

Let's go beyond to see the map here was showing you what you selected. So we see that we are looking at information for people with a disability who make an income of less than $50,000 in 2010. And you can see here all the components we have a map and a bar chart in a data table and as I scroll over any of these components, there all interactive and connected. You can see that they are highlighting each of the three areas. If you want to change the data you are looking at, you do that using the Data Display button. Let’s see—next, and I will open a menu and you click down through the levels. Currently we are looking at less than $50,000 for people with disabilities for 2010. But maybe we want to look at people who make over $50,000. Disability 2007 when I click there, the page will refresh to show the new information. And you'll notice that as I change the information, the scale changes and the colors change to the data. Whatever you choose to view on this page, the scale is going to match to the data that lives behind that. Be really careful and pay attention to the numbers that you are looking at. 

Again, we see it is really interactive and as I scroll over, everything matches. If you want to view data for a state, what they want to look at Wisconsin, you discover over the state and text box will pop up showing the indicator value for that state. Here we see that 30.8 percent of people with a disability in Wisconsin make $50,000 or more in 2000. And we can also left click on the state and it will highlight in dark green and the map and bar chart, and it will also be highlighted in the data table down here. To view a timeline for this information, click the timeline or bar chart button, and that is going to pull up the trend for this data over all of the years available. And just as a note, you have to have a state selected in order to view this timeline. Or multiple states but something has to be selected. If you want to compare to the states around Wisconsin, we can do that by hovering over those around. We see Minnesota's at 43.5, Iowa is at 36%, Illinois 41.8%, Indiana 30.9%, keep in mind that Wisconsin is at 30.8%. We can also look at the region for Wisconsin if we only want to compare it to the state and it's region. And we do that by clicking select ‘Census Area’, ‘U.S. Census Division’, and we also have all of the U.S. Census Regions. And I believe Wisconsin is in the West North Central division. We will click that. East North Central division. There is Wisconsin. We will click back to the bar chart. And we see now that if we click Wisconsin, left clicking again, we now see how it compares only to the states in the division. You can get down to the information that you are most interested in. 

We can also look at the region. Midwest region. So then if I click Wisconsin again, we see how it compares to its region. I will clear that by right clicking and I will clear my selection, so that unselects Wisconsin and I'm also going to clear the census area or filter. And I will show you that we have this other table functionality, state or census area table. If I click that it's going to topple the table and pull open a national region so they want to do with the United States averages, for people with disabilities who make income $50,000 or greater, we see that here in this table. So I can highlight it and see that that percentage is 35.1%. I will bring up the line here in the bar chart, and I will do so in a timeline too. As I mentioned we need to select a state so we can compare Wisconsin to the United States average. Looks like they are doing a little bit better in the beginning and then slightly lower for 2006 or 2010.  A couple of other neat things that we can do on this is you can customize the look. If we click map legend settings, it will open a box to change the color palette. If we wanted to change it to green, we can see the mapping green. And we can also increase or decrease the number of data classes. If you want to change how many times the data are split up into intervals. You can do that here. 

This other button here, it just opens a screen that will give you more information about the day that you are viewing. The shows you that you're looking at income level among adults 18 years of age or greater by disability status. Gives you some information on the data source and where you can find the definition and some analysis details and table and chart notes. You can really try to understand what you are seeing. I will close this. And those are the basics of the interactive map that we have available in the system. I will go back out into the maps and data tables and look at another piece of data. This time we will go into some health data. And I will close this up to keep it clean. We see we have open health topics. And I will go into health risks and behaviors. I will go down here, smoking and tobacco. And we will look at smoking status. This time I want to show you what our five year average by demographic groups looks like. We will click on that. And again, it brings up a screen showing you the viewing options you have. For this information you can look at interactive maps or you can look at data tables. And we will go into the customizable data tables because I want to show you how valuable this piece of the website can be so you can really get a lot of information at the same time in the table. 

This works the same way as the other data tree, the checkboxes open up the indicators underneath. Smoking status as former smoker and never smoked, if you're a map you would only be able to look at one of those at a time. We recognize it might be useful to look at them all together at the same time. By continuing to click down through the plus side, we can go into current smoker, people disability, perhaps you want to look by age. And look at age 18 to 44. People with a disability who are current smoker. And we want to select the same information for former smoker, people with a disability, age, 18 to 44, 2010.  And also do the same for never smokers. I am clicking the plus-sign to open up all the levels underneath. Until he get down to the time period. Once you have chosen the pieces of information you would like to view, click update data table in the pages going to load with your table underneath. We were able to build a table with current smokers, disability age 18 to 44 and the same for former smokers and the same for never smoker. And scroll down, you can see that we have all these pieces of information for all the states and at the bottom, we also have it for United States and territories and all the regions and divisions. And the neat thing about this functionality is the options in this banner here. If we wanted to download this table to Excel, rather than having to select the entire data set and work through that, we can download the data table here. And it's going to open in Excel. Only the pieces of information that I've selected. That's a really great functionality because it really allows you to get at the pieces of information that you plan to use. I have extracted only the three pieces of information that I am most interested. The same thing works here for the e-mail data table. I can click on this and send an e-mail to myself or someone else.

That will allow you using whatever your e-mail client is and is going to allow you to e-mail that specific data table to yourself or to save it for later. I am going to go back in. You will get some practice with the maps and data tables. Will go back into maps and data tables. Into disability data, health topics, groups and behaviors, smoking and tobacco, smoking status, five year average by demographic group, should and again, that just takes the health topic and is stratified as that by disability status and then further stratified. We’re going into data table customizable. And we will build another one here. I will show you a different one. We can open up smoking status, and as an example if you want to look at current smoker, people with a disability of all age groups, we can click this button and select all age groups. So that is going to select all age groups, and maybe we also would like to see the same thing for no disability so we can compare people with disability and without disability across the age group, for all years. And update the data table. This one will take a little bit longer. And you see here that we have disability, age 18 to 44 for current smokers, age 45 to 64, age 65 plus, and also the total. Again, it really allows you to build the tables to the information you're most interested in. That is the customizable data table. We're going to go back out one more time to maps and data tables and look at a different indicator. We will do a review of what I've shown you before, and then hop on and show you something else. 

I will close out health risks and behaviors and go into prevention and screening. And we will go into cancer screening. We were look at mammography. Disability data, mammogram, one year at a time. And again, this page shows you all of the viewing options that you have for this piece of information. Like I showed you before, we have this map which is the single map, on a page, and it allows you, the most useful thing about this book is to be able to see the piece of information you are interested in. For example, people with a disability who got a mammogram in 2010 and see how that compares across the state. You are looking to compare to each other and how your state compares to the region and the division and the United States average. If we go back again, data table customizable allows you to get those pieces of information into one data tables so you can look at them together. And then the interactive comparison map allows you to look at multiple pieces, two pieces of information at the same time. Brian will get on and talk to more about that and how it can be used to generate some research questions. Brian, would you like to talk about that? 

Brian Armour, PhD with NCBDDD:
Sure. Good morning everybody. Delighted again to be with you today. I'm going to talk briefly about the uses of the system. What I would like to emphasize is that what you can do here with this surveillance system is generate some research questions. Last week I talked about mammograms in particular. I also talked about obesity in the last three months and what I did was they showed state-level variation. I want to choose something -- I want to look at oral health. Again, just to give you a flavor of what is going on here. Oral health, and I will get dental visits in the last year. Here we go, dental visits last year. I lost my place for second. I want to talk about the double mask. And again, if you remember from last time, what exactly we did. We are seeing people with disabilities who visit a dentist in the last year. That is what is on both maps here. And that is what is on this area here. You will see the scales are exactly the same. What you can do here is I will leave this first mapping table on. I will look at the second. I can compare people with disabilities to those without for 2010. And what you will see is scale changes. And so you'll see that people with disabilities are represented on the X access and people without disabilities on the Y axis. And you can see the numbers here are a lot higher for people without disabilities compared to those with. And that just means that they're more likely to see a dentist in the last year. What that tell us you, here's one for Virginia. What that says is 61% of people with disabilities in Virginia saw a dentist in the last year. Compared to 80 percent of people without disabilities. And again, this is surveillance, so the surveillance system is showing you these differences. And where research comes into it, the surveillance describes the issue here and what is the issue? The issue is we are trying to identify opportunities to improve health and wellness for people disabilities by comparing.  And the research comes into it is trying to explain what drives the differences. 

Why do we see all this variation? Virginia for example, we see there is a 20% difference. As we scroll down here to Texas, the difference is ten percentage points. We are seeing variations, not only across states that between states. Across a variation that is really interesting. And that adds the question, what are driving these differences? One of the benefits of the system is the surveillance system allows you to identify opportunities to improve health and wellness. Other than what you see in terms of research what you do next is look at these they level differences I wonder what explains it. And that is the next step—the system does not answer those questions. But it generates those research questions for you by looking at this map. And that is why we have this plot here to the right, which is plotting one type of data against the other. In this case, people with disabilities. I wanted to remind you that you can also look at the disparity as opposed to people without disabilities. Again, what this is saying is everything is below zero here. What this is saying is that in every state, people with disabilities are less likely to visit a dentist in the last year compared to people without disabilities. I think when I say this, or indicator, I am just awestruck. I am dumbfounded you really see opportunities to improve health and wellness for people with disabilities. And I just want to briefly cover one more thing. 

The maps and data tables. What I'm trying to show here is the breadth of the information that we have here. If we look at barriers and cost of health care, health care coverage, basically what this means is do you have insurance? This is another indicator that I was just really surprised and if we look at the single amount, and we display data that, health topics, healthcare coverage, yes, and what I am looking that is I want no here. These are people disabilities that do not have insurance. I'm just surprised that in some you find that more than 20 percent of people with disabilities do not have healthcare insurance. It really surprises me when I saw the submission. And I know that's not new for some of you, but it was a bit of a surprise to me. You can see that the variation is 26 percent of people with disabilities do not have health insurance. Compared to Connecticut, where it's under 6%. Just amazes me the state-level variation. And again, one less thing I would like to cover. Maps and data tables, prevention, we will close some of this up and make it a little cleaner. Barriers and cost again. Now I want to look at -- due to cost. What this means is I did not see a doctor because I could not afford to see the doctor. You can look at the exact wording of the question and the health topic. If you look at the double map and comparing people with disabilities to those without and again, it defaults to disability. I will just look at those without disabilities only Y. axis. And again, what you see is not much difference here in long. But in these other states you see tremendous variations. In New York for example, you see 20%, 21 percent of people disabilities are reporting that they could not see a doctor because of cost as a barrier. Approximately 11 percent of people with disabilities. Again, this is surveillance. You see these differences, and huge differences at the state-level. You can see Florida, 33 percent of people with disabilities, one in three, could not afford to see a doctor because cost was a barrier. You just see the tremendous variation. The large system describes this variation on a state level. Again, more research comes into play as trying to figure out what is driving these differences, and why are people disabilities less likely to get the healthcare services. 

We know they face all types of barriers. That concludes my comments. Thank you. 

Michelle Sloan, MA from CCI, SAIC:
Thanks Brian—that was great. The last thing that I want to show you is the help content which I mentioned earlier. Now that you have seen the system and you've got an idea of how to work the system, I want to go through the help content so you can see how you can use those resources to remind yourself how to work with DHDS. I go to home and it opens up to the study guide. This walks you through the navigation of the site content which is essentially what we have done with you today. If you need a reminder of anything, it goes to the homepage, talks to about what is on the homepage, and then it goes to the maps and data tables, how you can access that, what that page is going to look like and how you can find data using that page. And again you can see some screenshots or you can use that as you walk through the system so you know you are doing correctly. A reminder saying that, I am on the right track. This really will walk you through the entire system. To remind you how you can get to the information you’re most likely to want. We will go back to the top. We'll so have an interactive map guide. And this one is for the map that I showed you, which is the one with just a single map on it. The bar chart, data table, a little note talks and legend. And this is really great since we were able to come up with some real tasks that people were really likely to want to do on this page. And you can go back to these and use them for reference if you have forgotten something that I went over to do. For example, say you want to know how to look at just the division or region, which I showed you for Wisconsin. And you forgot which button is what they use. You can click on that sentence and that will jump you to some information on the task and it will tell you I click the census area button, and I used the area to expand and walks you through how to do each of those tasks that we have listed. 

How do I compare the data value for my state with that of another? You just select the state and then hover over another to see the text box. It can remind you about the functionality. The other thing about this that's really great is on the screen shot here, this picture, if you have forgotten or need a reminder on any of the elements that I want over, maybe you don't remember how to work with the table very well, if you click on the table, it will jump you to information about the component of the report. You can read a little bit about that. That is the interactive map that. Same thing for the interactive comparison map which is the one that Brian went over just a second ago. We have information that you can click on an element or a number to jump you to some text information about that. Maybe the second map. That displays geographic borders, etc. and back to the top your, lastly is the customizable data table guide, and this one walks you through how to use the data table that I worked with a minute ago. And just reminds you of how to work with that tree and how you can select information here using the checkboxes and how to open up the tree down to the bottom level. Updating data table to build the table and that walk through the functionality of the links in that banner, which I wasn't able to touch on all of them. All of that information is in the guide. 

We have some general health resources for all the indicators and the site and how to go to the data tree to find that information. If you want information on arthritis, go to health topics, chronic conditions, arthritis, and arthritis against and it will take you to the information on the indicator. We have some FAQs, a glossary which is about DHDS specific terminology. And then references. In these lists all the papers that we use to build the site or validate the definition for the indicator within the site. The general references here at the top list the basic references for information and the data resources. And then indicator references are all the sources that we used to build the definition for the indicators. I will jump back to the top of the page. That is the help section. That is all that I have to say about that. And that is pretty much the end of the presentation. 

I just want to give a recap of the three things that we were hoping that you would get out of today. 1. An understanding of the data in the system. Like we said, you can see all the data through maps and data tables. You can see it in the help topic data guide and the demographic data guide. 79 health and demographic indicators by disability status. 49 of those also by psychological distress status and also expenditure information. The second thing we wanted was knowledge of how you can find and view the day that you are interested in and as a recap there are three ways to get into the data tables. The button in the middle, and the image here. The third thing that we wanted was an understanding of how DHDS can be used to generate research questions. Which building from the beginning to the end to surveillance, gives you an overview of what the data has and then Brian really got into the interactive comparison map -- see some unique things that are going on. Generates some questions you might want to look further into. 

Adriane may have some questions for us that we would be happy to answer to the best of our ability. 

Sharon Romelczyk, MPA from AUCD:
Thank you so much for your presentation. This is Sharon at AUCD. I want to encourage all the participants, if you have any questions, send them in the using the chat box feature and we will get those out to the presenters. We do have some questions here. Our first question for you is: are long-term care expenditures included and/or broken out in the data? 

Brian Armour, PhD with NCBDDD:
This is Brian. Long-term care expenditures are included in the expenditures. We have a few papers, and the paper which looks at state-level expenditures are not broken out in the national paper. And those two papers are listed I believe is references in the system. If someone would like to shoot me an email, I can get back to them describing what it would. 

Sharon Romelczyk, MPA from AUCD:
Thank you. We will be sure to provide the follow contact information for attendees. I've noticed that the timeline option and option to view interaction comparison met for psychological distress data are not available. Are there other limitations at the moment for data on psychological distress? 

Michelle Sloan, MA from CCI, SAIC:
The trend line isn't available for psychological distress as we only have it for one year. The 2007 year. That was a module during that year that we used to develop that aspect of the site. Given that we only have one year, we can't create a transparent. In the interactive comparison map, it is the same data that you can find in the interactive map, so we use the trend in mass, just to work with the limitations of how much information we could include in one view, there is not a trend line available on the interactive comparison map. It is the same information that you can get in the interactive map. 

Sharon Romelczyk, MPA from AUCD:
Thank you. The next question is does one need to have a separate statistical program to determine whether differences in the tables are statistically significant? If so, what program do you use? 




Brian Armour, PhD with NCBDDD:
I think you can look at the confidence levels in the displays. This is Brian. As long as they don't overlap in the customized tables, and they are statistically significant. We have 95% confidence in both of those, they don't overlap. Those differences are statistically significant. 

I will show how you can find that information because that is one of the buttons they did not mess with when I was showing the customizable data table. Even though we have had a question about it, I will do that quickly. I will go into smoking and tobacco, smoking status, and we will go into one year at a time. Go into the customizable data table. Again, I am just clicking down, I'm going to build something really quickly. I will take the current smoker update data table. It will load it. So you'll notice that it is loading only the year percentages for information I have selected. But if I click the show hide associated data am which may take a minute because this is a little bit of a large table, that is going to pull up for you the number, weighted number, standard error, standard error and the 95% confidence interval for each of the pieces of information. That will give you the information Brian was just referring to. 

Sharon Romelczyk, MPA from AUCD:
Great, thank you. Do you plan to provide data at the county level in the future and will you be expanding geospatial analysis capabilities for the disability data? 

Brian Armour, PhD with NCBDDD:
Those are good suggestions. I think what we would need to do is take those into consideration and have some discussions here at this time, I think. Thank you for the suggestions and we will take it further.  

Sharon Romelczyk, MPA from AUCD:
Great. Does the system have data showing Medicaid and Medicare usage? 

Brian Armour, PhD with NCBDDD:
I'm sorry, can you clarify what you mean by usage? 

Sharon Romelczyk, MPA from AUCD:
I will get back to the person who asked the question and we will follow up with a more in-depth description of that question. The next question is, is there data specific to developmental disabilities, particularly autism? 

Brian Armour, PhD with NCBDDD:
Unfortunately, no. There is no data available by diagnosis. Or condition. 

Sharon Romelczyk, MPA from AUCD:
Okay. One of the participants would like to know if class data is broken down by source of payment. 


Brian Armour, PhD with NCBDDD:
It is broken down by payer, Medicare, Medicaid, private pay, yes. Maps and data tables, expenditures, under healthcare expenditures associated with disability. And we will look at the high contrast. We haven't done that yet. This is the same view of the one I've been showing up. Just different colors to try to help the contrast for people with visual impairments. Here you can see that if I open this up, we have expenditures, Medicare, Medicaid, and nonpublic sources. Again, they are $2006. 

Sharon Romelczyk, MPA from AUCD:
Great, thank you for the demonstration. The next question is how often is this database updated? 

Brian Armour, PhD with NCBDDD:
Great question. Was recovered at because it's a very good question. We plan to update it annually. And it will be updated with the -- but as soon as it 2011 data is there we will get it in as quickly as we can. But there's a lot of analysis involved, so it's not want to be the day after it is released. It will take several months. But we hope to get the information -- so is timely and can be used in a timely manner. You will notice the 2011 data is not -- and we have the latest information there for 2010 for all but two states. 

Sharon Romelczyk, MPA from AUCD:
Great. The next question revolves around the graphical display of data. Is there any way to define labels for the X and Y axes when you are comparing different variables? 

Brian Armour, PhD with NCBDDD:
I'm not sure. That's a good question. I guess that we can look into that. Perhaps and the future. My colleagues here are shaking their heads no. But it's a good suggestion. I guess there's a good reason for it. 

Michelle Sloan, MA from CCI, SAIC:
I'm assuming that this person is asking about the interactive comparison map that Brian was talking about him and we recognize that that is a little bit of a limitation with that view, because currently it just says Data 1 and Data 2. The catch is that in order to get a label down there, we can’t do it based on the indicator that you have selected because it is so long. You can't even read it. We tried that, and is present in the future, we are working on the, possibly trying to do some sort of shorthand, but currently, it is just a limitation of our system, and we recognize that that is not the best option, but hopefully you can draw the connection from beta-1 to the first data on top until we can see whether we can do something about that. 

Sharon Romelczyk, MPA from AUCD:
Thank you. The next question is can you select out the frequency with which persons with disabilities seek out preventative healthcare as compared to persons without disabilities? In the second part of the question is other any statistics on the financial impact of the apparent greater difficulty of persons with disabilities obtaining that preventive healthcare? I guess that financial impact of access to health care. 

Brian Armour, PhD with NCBDDD:
Can you read the first question again? 

Sharon Romelczyk, MPA from AUCD:
Sure. The participant would like to see the frequency with which persons with disabilities seek out preventative healthcare versus persons without disabilities. 

Brian Armour, PhD with NCBDDD:
Michelle will pull up some information. Preventive service use, mammograms are one example which we cover less than. What you can see as Michelle pointed out, you can see for mammograms or flu shots, or doctor visits and checkups for dental visits, which I covered today, you can see by disability those without disabilities and for many of the indicators, you see that people with disabilities are less likely to use preventive services. And that's what was shown and again Michele is pulling it up for mammograms I think real quickly, one of that implications for that, I think that is a research question. And that is a level beyond -- this is a surveillance system but it's a very good question. And I think that it’s an excellent question and unfortunately I can’t answer research questions. 

See here on the double map I pulled a pair of the top which is data one, people with a disability who get a mammogram of people on the bottom people without a disability to get a mammogram and using this new, you can the two pieces of data that in the data table so that's what since people with a disability compared to people without a disability. You can also pull this up on the single map just as a mentioned before, you can see the two people information at the same time. That is our suggestion. You can do it for flu shots, dental visits, and all those types of preventive services. 

Sharon Romelczyk, MPA from AUCD:
Sure. Along those lines, how do print out one of these maps with the legend to go with it. 

Michelle Sloan, MA from CCI, SAIC:
My apologies for skipping over that. I will go back into the options and we will go into the interactive map and single map. Appear at the top you see we have two options here, save image and print. Save as an image allows you to save either the entire full screen, which would encompass the legend, and you can also print -- just the legend, just the title, and just the table. The bar chart of the United States and territories, though save to your computer as a JPEG or PNG. You can do the same thing with printing, full screen or any one of the components. My suggestion if you want only specific pieces of this is to save them that way and then pull them into a PowerPoint. I'm not quite sure what that person is asking that they want to do with it, but obviously the full picture is going to take everything that they see on the page. And then you can also get just one specific element if that is all you are interested in. Just the map in just the legend and then put them together on whatever presentation you are working on. 
Sharon Romelczyk, MPA from AUCD:
Thank you so much for showing us. The next question has to do with the data. Are all rates age-adjusted, even rates stratified by age? 

Brian Armour, PhD with NCBDDD:
All rates are age-adjusted, but you get the same values when you stratified by those aged. The adjusted value in the age though you is going to be identical. 

Sharon Romelczyk, MPA from AUCD:
Great. The next question is specifically about the percentage of people with Medicare for people with disabilities versus people without disabilities. And the person is particularly interested in New Jersey. If you could demonstrate that for us?

Brian Armour, PhD with NCBDDD:
Percentage of people 65 years or of age or older, who have a disability, or is it the expenditures that interested in a drink? We will show you how you can find percentage of people in New Jersey six or five world or with a disability. And if they want something else than they could follow up with us and we will be happy to try to catch up with him. 

Sharon Romelczyk, MPA from AUCD:
That sounds great, thank you. 

Brian Armour, PhD with NCBDDD:
Thinking on demographics, going to the map this is showing us percentage of people with a disability in the 18 to 44 age group in 2010. This person wanted to see 65 plus, again we click over here to data and then click down through 65 plus in 2010, and they wanted New Jersey. So I’m going to go here in the data table and click New Jersey. And then if I want to see that a little more clearly, I can put this arrow in the top right of the map, and it's going to make it bigger. and blow it up. So I can really see New Jersey here. And you can see New Jersey, 33.2% -- age 65 or greater -- if you can figure out the expenditures are by looking at the expenditure us meant. And again, to be eligible for Medicare, you have to be 65 years of age and 95% of Americans 65 world or are eligible. You can get a good proxy for that using this. But we're not sure that we are inching the question. We need a little more information. Hopefully this helps. 

Sharon Romelczyk, MPA from AUCD:
Great. The next question is our raw data rather than aggregated data available to use for more advanced analyses? 

Brian Armour, PhD with NCBDDD:
Yes, you can find loads of raw data from the BRFSS website. If you google it on CDC, you can download all the data to support that. What we've done is we've tried to make it easier for your purposes, we have taken all that raw data, we start the programs, make sure we were measuring variables and run all that analysis. The stratification and the weighting, etc. and the statistics, but if you've got the software and the skills that can run that -- then yes, and it is all available for purchase. 

If you want to just the data behind our system you can do that through the Excel download that I showed in a combat them together in whatever way you would like for a report or whatever else you want to do. If you want to take that avenue for the already analyzed data. We split it out here for you. 

Sharon Romelczyk, MPA from AUCD:
Thank you so much. I would like to encourage the participants, if you have any additional questions, to please send them in via the chat box. We really do appreciate your questions. I think we will give them a minute to send in any other questions they might have. 

In the meantime, we did get a suggestion and I guess this could be a question. Is data for children and youth with disabilities to be included in the future? It is definitely more of a suggestion. 

Brian Armour, PhD with NCBDDD:
Thank you for that suggestion. It's something I think we would need to discuss internally. Thank you for the suggestion. 

Sharon Romelczyk, MPA from AUCD:
Yes, great. We have a question specifically. Not sure if you touched on whether the data can be broken down by different types of this abilities, but someone was looking to get national statistics of people with mobility impairment in particular. I didn't know if you wanted to touch on that. 

Brian Armour, PhD with NCBDDD:
I think the functional definition of uses the can of people with mobility impairments. Based on some of the work we're doing. I think this has really done a good job of taking up folks with mobility impairments. If you wanted to specifically look at folks with mobility impairments, it's not available in the system but you know how to run rough data that is out there, it is available through the national NHIS. In the questions the folks at NHIS and CHS could give you ideas on how you can do that. Thank you. 

Sharon Romelczyk, MPA from AUCD:
Great, thank you. Thank you so much. I will pass it back to Adriane for her final remarks. 

Adriane Griffen, MPH, MCHES from AUCD:
Thank you Brian and thank you Michelle. We really appreciate this demonstration, of this fantastic virtual tool. I want to remind everybody that you can help spread the world about the DHC is tool being available. You should have received some tip sheets and fact sheets on the tool. Those are also available at CDC.gov -- and they are in the tool section. We encourage you to do that and share them with your staff. They think this is a fantastic visual for capturing the system. And we also want to say thank you for the participants and your active questions throughout the question-and-answer period. If you do have other questions about the DHDS, please feel free to send them into CDCinfo@cdc.gov or call 1-800-CDC-info. That is CDCinfo@cdc.gov or 1-800-CDC-info. Thank you again Brian and thank you Michelle. We will be recording today's webinar and archiving it and sending that out to all the participants shortly. Thanks so much everybody.
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